Health and Family

Health Risk Factors

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Health Risk Factors

By taking several simple steps, Virginians can improve their overall health prospects, quality of life, and longevity. Adopting a healthy lifestyle and getting regular checkups (to cover preventive tests and immunizations and to control chronic conditions) can both pay big dividends.

An unhealthy lifestyle -- one characterized by more than one health risk factor present -- often creates a host of debilitating health problems, exacts a terrible toll in suffering, and carries a hefty economic price tag. Virginia is committed to promoting healthy lifestyles, starting in childhood, to help citizens live long, productive lives.

Why is This Important?

A healthy lifestyle is one in which individuals eat nutritious foods, regularly engage in physical activity, avoid smoking and substance abuse, consume alcohol in moderation, and get regular medical checkups. Immunizations are another vital tool for maintaining health -- a line of defense against some of the most deadly infectious diseases known. Living an unhealthy lifestyle often results in lost workdays, lower productivity, and negative health outcomes, including chronic disease; it also strains private and government health care resources. Adults with more than one unhealthy behavior are nearly seven times more likely to report having poor or fair health than those with no unhealthy behaviors.

How is Virginia Doing?

Use the quick menu below to jump to a particular health risk factor.

DietPhysical ActivityObesityDiabetesSmokingHeavy Drinking and Substance AbuseImmunizations


Americans Reporting They Consumed at Least One Serving of Fruit and One Serving of Vegetables per Day, 2013. See text for explanation.

The USDA Center for Nutrition Policy and Promotion's Dietary Guidelines for Americans recommends a balanced diet for adults that contains 2-3.5 cups of vegetables and 1.5-2.5 cups of fruit per day. However -- at best -- fewer than 15 percent of Americans comply with this advice. Based on frequency of intake (rather than quantity of consumption), results from the CDC Behavioral Risk Factor Surveillance System (BRFSS) indicate that many people fail to eat a single serving of fruit or vegetable each day.

Americans Reporting Getting Adequate Physical Activity. See text for explanation.

In 2015, 59.9 percent of Virginians reported consuming one or more servings of fruit per day, a drop from 62.6 percent in 2013 and below the national average of 60.3 percent, ranking the state 26th nationally. Virginians who reported consuming one or more servings of vegetables per day also declined slightly from 2013 (78.6%), to 78.3 percent; this was above the national average of 77.9 percent and ranked Virginia 24th.

Virginia's percentages were also higher than peer state Tennessee (54.9% and 77.4%) and North Carolina (56.7%) for fruit consumption; among all peer states, Maryland had the best performance (64.0% and 78.7%). The national leader for fruit consumption was New Hampshire (66.7%). Oregon placed first for vegetable consumption (83.5%).

Physical Activity    back to menu

Americans Reporting No Physical Activity, by State. See text for explanation.The US Department of Health and Human Services's Physical Activity Guidelines for Americans recommends that adults need at least 150 minutes of moderate-intensity aerobic activity/75 minutes of vigorous-intensity exercise and two or more days of muscle-strengthening activities each week. Among Virginians, 22.1 percent of adults reported in 2015 that they met that standard. This rate was above the national average of 20.3 percent and ranked 15th among US states. Maryland (22.9%) had a higher exercise rate, while North Carolina (18.9%) and Tennessee (17.8%) were lower. Colorado was again the leading state at 26.2 percent.

Virginians reporting no physical activity. See text for explanation.However, some adults reported participating in no physical activity during the previous month. Among Virginians in 2015, 25.2 percent reported getting no exercise within the past month, a bit better than the national average of 26.2 percent. Peer states Tennessee (30.4%) and North Carolina (26.2%) were higher than Virginia, while Maryland (24.1%) was lower. The national leader was Colorado at 17.9 percent reporting no exercise within the last 30 days.

Within Virginia, the Southside (30.0%) and Southwest (29.2%) regions reported the highest rates of physical inactivity in 2012, the latest year for which data is available; the Northern region reported the lowest (17.5%).

Obesity    back to menu

Obesity Rates by State. See text for explanation.Being overweight or obese typically results from an energy imbalance that involves eating too many calories and not getting enough physical activity to use those calories up. After two years of decline across 2012-13, Virginia's obesity rate rose in 2014 and again in 2015, to 29.2 percent, ranking the state 22nd best in the country.

Though still lower than the latest national average (29.8%), as well as Tennessee (33.8%) and North Carolina (30.1%), Virginia's 2015 obesity rate is back to where it was in 2011. At 28.9 percent, Maryland came in somewhat lower than Virginia. Colorado, which has led the nation in lowest obesity rates since 2000, again led in 2015 with 20.2 percent.

Obesity Rates by Virginia Region. See text for explanation.

Within Virginia, obesity rates rose in every region except the West Central and Central regions in 2014. The Eastern region had the highest obesity rate at 39.2 percent, followed by the Southside region at 36.9 percent. The Northern region had the lowest rate of obesity at 21.2 percent.

Obesity often begins in childhood and is difficult to change once it has been established. The CDC's 2013 Youth Risk Behavior Surveillance System (YRBSS) found that 26.7 percent of Virginia's high school students were overweight or obese, a decrease since 2011 of 1.6 percentage points. Obesity Rates for Childrenby State. See text for explanation.This figure puts Virginia below the national average of 30.3 percent and ranks the state 20th best in the country for percentage of overweight or obese children. Virginia's rate was lower than Tennessee (32.3%) and North Carolina (27.7%), but higher than Maryland (25.8%). Utah was again lowest in the US at 17.5 percent.

Diabetes    back to menu

Self-reported Diabetes Rates by State. See text for explanation.

One metabolic complication of poor diet and obesity is diabetes. In 2015, Virginia's self-reported diabetes rate rose to 10.4 percent, above the national average of 9.9 percent and ranking the state 30th. Virginia's rate was lower than peer states Tennessee (12.7%) and North Carolina (10.7%), but a tick higher than Maryland (10.3%). Colorado had the lowest diabetes incidence at 6.8 percent.

Self-reported Diabetes Rates by Virginia region. See text for explanation.Virginia's regional patterns with obesity are similar to other health risk measures: The Northern region has the lowest diabetes rate at 7.2 percent, while the Southside (13.8%), Eastern (12.8%), and Southwest (12.3%) have the highest. As of 2012 (most recent data available for localities), every region except the Northern one largely continued to see diabetes incidence rise; however, state-level data from 2014, which shows dropping diabetes rates in Virginia from 2013 on, suggests that regional rates have also declined in the years after 2012.

Smoking    back to menu

Smoking Rate by State. See text for explanation.

Smoking is the second most important risk factor in early death. In 2015, Virginia's adult smoking rate dropped to 16.5 percent, lower than the national average (17.5%) and ranking the state 20th in the nation. The percentage of people smoking in Virginia in 2015 was lower than in North Carolina (19.0%) and Tennessee (21.9%), but higher than in Maryland (15.1%). Utah again led the nation with an adult smoking rate of 9.1 percent.

Smoking Rate Among Virginia Teens. See text for explanation.

The Virginia Foundation for Healthy Youth recently reported that the percentage of high school students in Virginia who are regular smokers has declined from 28.6 percent in 2001 to 8.2 percent in 2015.

Heavy Drinking and Substance Abuse    back to menu

Heavy Drinking Rate by State. See text for explanation.

Excessive alcohol consumption and substance abuse are also top 10 risk factors for early death. Heavy drinking is defined as two or more alcoholic drinks a day for a man and one or more for a woman (both of average weight and height for their respective genders). Virginia's self-reported heavy drinking rate went up to 5.9 percent in 2015, equal to the national average. All peer states had lower heavy drinking rates: Maryland (4.9%), North Carolina (4.7%), and Tennessee (4.7%). West Virginia reported the lowest rate -- 3.5 percent -- of heavy drinking by adults in 2015.

Substance Abuse Rates by State. See text for explanation.

Substance abuse is a growing problem in Virginia and elsewhere in the country. In 2014, 980 Virginians died from drug overdose, up from 856 in 2013. Most of these deaths were caused by prescription painkillers and heroin. The problem is growing rapidly in the state's rural regions, including Southwest Virginia.

Excluding marijuana, Virginia's rate of substance abuse for the heaviest user group (18-25 year olds) was lower than the national average. Virginia's drug use rate dropped to 5.5 percent in 2014, compared to the nationwide rate of 6.6 percent. Virginia's rate was also lower than peer states North Carolina (7.3%), Tennessee (6.4%), and Maryland (6.2%). Wyoming had the lowest rate of reported substance abuse in 2014 at 4.6 percent.

Immunizations    back to menu

Childhood Immunization by State. See text for explanation.

Virginia's vaccination rate for children has fluctuated in the past decade, within a range of 70 to 82 percent. More recently, Virginia's child vaccination rate rose from 74.6 percent in 2013 to 79.3 percent in 2014 -- above the national average and lifting Virginia's national rank to 9th best. Maine had the highest child immunization rate in 2014 at 87.3 percent. Virginia's rate was higher than Tennessee (72.6%) and Maryland (77.8%), but lower than North Carolina (83.0%). The national immunization rate stood at 74.6 percent.

Flu and Pneumonia Immunization Rates for Virginia Adults. See text for explanation.

Data from the Behavioral Risk Factor Surveillance Survey (BRFSS) shows that influenza vaccination rates in adults age 65 years and older dropped again in 2015, to 61.5 percent; the high point remains the 63.3 percent flu vaccination rate seen in 2011. However, pneumonia vaccinations in older adults rose to a new high in 2015, to 74.3 percent.

What Influences Health Risks?

A healthy lifestyle -- including proper nutrition, regular physical activity, and avoidance of risky behaviors -- plays by far the most important role in determining health outcomes. The choice to adopt beneficial behaviors is itself influenced by a host of other factors, including individual personality and temperament, family and social networks, access to regular preventive care, media messages, the availability of healthful or harmful products (e.g., fresh fruits and gym facilities vs. drugs and firearms), the physical environment, and genetics.

Socioeconomic status is a major factor in the adoption of a healthy lifestyle. Educational attainment is linked with good health behaviors, in part because more educated individuals are more knowledgeable about the health consequences of an unhealthy lifestyle. Those with higher educational attainment also tend to have higher incomes, benefit from employer-sponsored health insurance, and enjoy ready access to a wide variety of healthful foods.

Primary and secondary public school investments also play an important role in promoting healthy behaviors. Developing the cognitive and non-cognitive skills which influence lifestyle decisions well into adulthood is one aspect; so are the lessons directly imparted about healthy living, as well as the type of healthful eating modeled in school-provided meals.

Lower-income areas typically suffer from a less beneficial physical and social environment, including higher incidences of crime, violence, and substance abuse. The phenomenon of "food deserts" -- where fresh and nutritious foods are not readily available or affordable without traveling long distances -- are also associated with poorer communities, even those located in bustling and prosperous cities.

What is the State's Role?

Although adopting a healthy lifestyle is ultimately the choice of each individual, states are able to influence public health behaviors in a variety of ways.

  • Planning and Coordination. The state can play an important role in promoting healthy lifestyles by the development of an aggressive, coordinated strategic plan for healthy living. For example, through Virginia's Plan for Well-Being, the Virginia Department of Health is developing partnerships with local communities, schools, and medical providers to develop local initiatives to improve nutrition and physical activity.
  • Education. State and local health agencies help educate the public about the importance of healthy lifestyles and direct them to other resources available for health promotion. Marketing and media campaigns target disease prevention and educate the public about health issues such as smoking, diet, and illegal drugs. Because many health behaviors take root during childhood, public schools are able to influence the adoption of healthy lifestyles through their provision of nutritious meals, restriction of access to unhealthy foods, and mandating participation in physical and health education.
  • Infrastructure. Through its funding of transportation infrastructure and parks, states can affect the physical layout of communities, including walkability and accessibility of parks and recreation facilities. Research indicates that these features enhance the likelihood of physical activity. Local zoning regulations also have an effect on the built environment, including the availability of mixed-use developments that affect the jobs-population balance, time spent walking, and length of commuting by vehicle.
  • Access to Preventive Care. Under the Affordable Care Act (aka Obamacare), every insured individual must be provided the basics of preventive care -- an annual physical and routine screenings and tests -- free of charge, including no patient co-pays. One way the Commonwealth can improve health behavior is by reducing the number of uninsured residents who now lack access to such preventive care. Local health departments do provide certain disadvantaged individuals with some preventive services -- including immunizations and screenings for infections and chronic medical conditions, as well as counseling and education sessions on topics such as such as smoking cessation and nutrition. 
  • Tax and Regulatory Policy. States may use their tax, subsidy, and regulatory powers to decrease the attractiveness of harmful products and increase the availability of good ones. All of these strategies have in fact been used to good effect in changing health behavior. For example, states tax cigarettes and alcohol at higher rates than other goods and services, while regulatory policies restrict tobacco advertising, put prominent health warnings on alcohol and tobacco products, and prohibit the sale of tobacco and alcohol to youth. By enforcing laws designed to protect public safety (e.g., drunk driving penalties), states are also able to deter many individuals from engaging in risky behaviors.
Updated June 22, 2017

State rankings are ordered so that #1 is understood to be the best.

Data and Definitions

Adult Diet, Exercise, Obesity, Smoking, Alcohol Use, and Vaccination Coverage
State and Regional Data: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey (BRFSSS) Data. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2013.

  • Diet: Consumed fruit one or more times per day; consumed vegetable one or more times per day
  • Physical Activity,2013-2015: Participated in enough aerobic and muscle strengthening exercises to meet guidelines (i.e., at least 150 minutes per week of moderate-intensity aerobic activity, or ≥75 minutes of vigorous-intensity aerobic activity and muscle-strengthening activities at least two times per week)
  • Physical Activity, 2011-2015: Participated in any physical activities during the past month
  • Obesity: Body Mass Index (BMI) of 30.0 or over
  • Diabetes: Ever been told by a doctor that you have diabetes?
  • Alcohol: Heavy drinkers (adult men having more than two drinks per day and adult women having more than one drink per day)
  • Adult Vaccination: Adults aged 65+ who have had a flu shot within the past year; adults aged 65+ who have ever had a pneumonia vaccination

NOTE: Estimates / comparisons before 2011 were dropped due to sampling methodology changes.

High School Obesity
State Data: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance System (YRBSS)

High School Smoking
Virginia Foundation for Healthy Youth, Virginia Youth Health Survey

Substance Abuse

Centers for Disease Control and Prevention (CDC)

Estimated vaccine coverage with 4:3:1:3:3:1, which includes: 4 or more doses of Diphtheria, Tetanus & Acellular Pertussis Vaccine (DTaP); 3 or more doses of Poliovirus; 1 or more doses of Measles, Mumps & Rubella Vaccine (MMR); 3 or more doses of Haemophilus Influenzae Type b (Hib); and 3 or more doses of Hepatitis B Virus (HepB) and 1 or more doses of varicella vaccine.

This immunizations survey includes a margin of error ranging from 1.4 percent on national estimates and up to 9.2 percent for some state estimates; estimates / comparisons before 2011 were dropped due to sampling methodology changes.

See the Data Sources and Updates Calendar for a detailed list of the data resources used for indicator measures on Virginia Performs.

At a Glance:
Health Risk Factors
in Virginia

Performance Trend: Trend is improving.
State Influence:

National Ranking: Virginia currently ranks as follows for the health risk factors discussed here: Healthy Fruit / Vegetable Diet (26th / 24th), Adequate Physical Activity (15th), No Physical Activity (22nd), Obesity (22nd), Obese Children (20th), Diabetes (30th), Smoking (20th), Heavy Drinking (27th), Substance Abuse (10th), Childhood Immunizations (9th).

Virginia by Region: The Northern region consistently has the highest percentage of residents with healthy lifestyles.

Related Agency Measures

State Programs & Initiatives

The Virginia Department of Health (VDH) is the chief state agency managing a wide range of health services for the Commonwealth, including epidemiology (disease prevention and control), emergency preparedness and health services, environmental health, family health and wellness, pharmacology, forensic medicine, even healthy drinking water.

VDH has just launched a new "Plan for Wellbeing" that outlines specific goals and strategies for communities in order to make measurable health improvements across the state by 2020. 

The Virginia Department of Behavioral Health and Developmental Services (DBHDS) funds Community Services Boards (CSBs) to deliver mental health services to poor and disabled residents.

The Virginia Department for Aging and Rehabilitative Services works with 25 local Area Agencies on Aging and other agencies and organizations to deliver certain health, nutrition, and rehabilitative services to seniors in need.

Additional Information

America's Health Rankings has offered an annual assessment of the nation's health on a state-by-state basis for nearly 30 years.

County Health Rankings provides an annual snapshot of how health -- on measures ranging from obesity to unemployment to teen births -- is influenced by where we live, learn, work and play.

The Kaiser Family Foundation offers a wealth of information on the state of health care in the US, covering topics as diverse as women's health policy, Medicaid/Medicare, and health reform. The foundation also offers detailed state-oriented data, plus various status reports for many states, including Virginia.

Did You Know?

heart with EKG lineWomen are at just as much risk for developing heart disease and dying from cardiovascular problems as men. Check out an informative Fact Sheet from the Centers for Disease Control.